Rambai, a lean and sprightly 34-year-old, has never been the quiet sort. So when her neighbours at the Rokra hamlet were asked to choose a community health worker (CHW) — called Mitanin (friend) in Chhattisgarh — they knew that Rambai would be an ideal candidate.
“We selected her because she could communicate well and interact with officials with ease, even though she has studied till Class 5,” said Laxmibai, her neighin Rokra, a forested 37-family hamlet in the coal-rich Manendragarh block of Korea district in northwest Chhattisgarh.In the last five years that she has been a Mitanin, Rambai, a Cherva tribal, has managed to carve out a niche of her own. "There were many in the para (hamlet) who were afraid to get their children immunised," said Rukmun Bai, another neighbour. "But Rambai would patiently, but firmly, explain its benefits to us. Now mothers go to her to ask about the dates for the next round of immunisation."
It’s also due to Rambai’s interventions that more and more women of Rokra are opting for hospital deliveries. The training given to her by the State Health Resource Centre (SHRC) enables her to detect cases of diarrhoea and malaria early and administer some basic medicines. “Very few children and people die these days of these two, thanks to her early intervention,” said Rukmun Bai. Mitanins like Rambai is the ‘last-mile connectivity’ between the state and the people. Earlier, an Auxiliary Nurse Midwife (ANM) was the last link, catering to nearly 5,000 people. Naturally, it was impossible for an ANM to cover every hamlet daily and be around for emergencies. Mitanins, on the other hand, look after 400 people on an average and are available 24x7 since they stay in the hamlet. The National Rural Health Mission has another level of workers called ASHA, who are positioned between the ANMs and the Mitanins. In fact, the Mitanin programme is a precursor of the ASHA programme.
“The main difference between this programme and other similar programmes is that it is voluntary and activist in nature. Mitanins are a representative of the local community rather than of the government,” explained Samir Garg, programme coordinator at the Raipur-based SHRC that overlooks the project.
“I knew there would be no salary. But people’s respect and the new things I can learn have made me carry on,” explained Rambai, who lost her husband very early into their marriage. People reach out to her whenever they need help. On an average, she spends two hours a day spreading the word about health initiatives of the state in her hamlet. “CHWs like Mitanins understand the local socio-cultural milieu and customise the health messages,” said Dr Ravi Anand, senior adviser, Clinical Services and Training at JHPIEGO, an affiliate of USA’s John Hopkins University.Rambai, much to the delight of the SHRC, has more than once gone beyond her duties as a health worker. A couple of years ago, she found that the primary schoolmaster was coming to the school drunk and siphoning off the rice meant for the mid-day meal scheme.
“I called a meeting in Rokra and explained how the schoolmaster was harming our children and formed a team to gather evidence against him,” recounted Rambai. “When our assumption was proved right, I wrote to the local administration, demanding his removal,” said Rambai emphatically. After an inquiry, the schoolmaster was transferred.
“To ensure that this is not repeated, Rambai started an attendance system for the school and now when the teacher wants to take leave, he informs her,” said Sukhwanti, 36, who was earlier a Mitanin herself, and is now a block trainer for the programme. However, Rambai’s biggest triumph came two years ago against the hardened forest mafia. “We gather mahua seeds, tendu patta and amla from the forests and earn a living by selling them. One afternoon, I got the news that a contractor was cutting down fruit-bearing and young trees illegally,” said Rambai.
To stop him, never an easy task since they have deep links within the local administration, police and politicians, she drummed up support in Rokra and its neighbouring villages, entered the forests and seized the equipment of the contractors. As expected, the contractor went to the police. “The police threatened and bullied us, but we did not budge. For days, we would stay in the jungles, even at night, and guard the trees,” added Rambai. A couple of months later, the Bilaspur High Court, which they had moved, ruled in their favour.
While for the community, Rambai’s initiatives have meant improved health, the Mitanin programme, has given her the confidence to aspire for more responsibilities. She hopes to be a trainer soon, like Sukhwanti. “But most of all, I want to save enough to ensure a decent education for my daughter,” Rambai said.